Industry Insights

California’s Unclaimed Medicare EMR

Travis Skinner

Director

Consulting

Health Care

Facilities nationwide are leaving Medicare Electronic Medical Record (EMR) incentive dollars on the table. By a considerable margin, California hospitals collectively have the largest amount of potentially unclaimed additional Medicare EMR incentive dollars.

Based on an analysis of one EMR program year’s current cost reports, eligible Medicare EMR California hospitals have a potential unclaimed Medicare EMR benefit of approximately $100 million. This estimated benefit is based on approximately 1.5 million annual Medicare Part C days potentially not on cost reports. These numbers are based on data for just one EMR program year. The Medicare EMR incentive program consists of four consecutive years of payments. Therefore, the magnitude of the overall effect for each facility could be significantly greater.

This issue could affect all facilities eligible to receive and that have received a Medicare EMR incentive payment. If you’re a Prospective Payment System facility that met or will meet meaningful use or a critical access hospital facility that submitted assets for incentive payments, this issue could still have a significant effect on your incentive dollars.

The numbers used in our calculations are based on Centers for Medicare & Medicaid Services reports, which show the Medicare Part C penetration rate for every county in the country by year. BKD has used these calculations to assist several facilities nationwide in proper census data reporting and to become eligible to claim hundreds of thousands of dollars more than originally estimated. This opportunity also can help avoid potential overpayments due to the cost reporting process and audits of the EMR data by the administrative contractor.

Contact your BKD advisor if you would like to discuss:

Your facility’s Medicare EMR incentive program situation

The potential four-year Medicare Part C effects

How to take advantage of this opportunity and claim the incremental reimbursement due to your facility